On July 9, 2021, President Biden issued an executive order (EO) containing 72 directives to more than a dozen federal agencies, many of which have broad implications for healthcare. Specifically targeted are healthcare competition, hospital mergers,... Read More
Frier Levitt recently helped an Arizona-based independent pharmacy that was being audited by a national PBM. The PBM alleged various audit discrepancies including inadequate proof of delivery and missing signature logs. These alleged discrepancies... Read More
In a growing trend, we have seen Pharmacy Services Administrative Organizations (PSAOs) recently undertake new efforts to withhold reimbursements due and owing to pharmacies after they have been terminated by one or more pharmacy benefits managers... Read More
The State of Texas recently enacted H.R. 3459, a law that permits prescribers to earn a “gold card” exemption from Prior Authorization (PA) requirements based on a track record of previous PA approvals from insurers (preferred provider and... Read More
Over the last 10 years the percentage of physicians that are directly employed by hospitals or by hospital owned medical practices has continued to grow. Physicians encounter obstacles in their attempts to preserve independence. One major obstacle... Read More
For community pharmacies, dealing with a Pharmacy Benefit Manager (“PBM”) audit has become a significant part of their day-to-day operation. It requires a pharmacy to spend scarce resources to respond to an audit but also to challenge any... Read More
This article examines Pharmacy Benefit Manager’s (“PBM”) “rebate walls” and the impact on the United States drug supply chain. The Federal Trade Commission head, Commissioner Rohit Chopra, recently issued a report on PBM rebate walls,... Read More
State legislative initiatives to regulate Pharmacy Benefit Managers (“PBMs”) have gained momentum. Arkansas successfully defended its state PBM regulation in 2020 before the United States Supreme Court. Now, more states have been enacting... Read More
During the past year, the COVID-19 pandemic has illuminated, more than ever before, the critical role government agencies have in virtually all aspects of our lives, including public health. The Freedom of Information Act (“FOIA”), 5 U.S.C. §... Read More
As Congress has made changes to the health care system over the past 30 years, nothing has impacted consumers' lives as much as the growth of pharmacy benefit managers (PBMs). Most consumers might not think that PBMs play a large role in their... Read More
